Disaster Mental Health Counseling

A Guide to Preparing and Responding

Jane M. Webber, J. Barry Mascari

• Publisher: American Counseling Association
• Year: 2017
• ISBN:
  9781119457435
• Edition: 4
• Topic: Education
• Subtopic: Professional Development

This timely book provides current research and skill-building information on Disaster Mental Health Counseling for counselors, educators, students, and mental health responders in agencies, schools, universities, and private practice. Recognized experts in the field detail effective clinical interventions with survivors in the immediate, intermediate, and long-term aftermath of traumatic events.

This extensively revised edition, which meets 2016 CACREP Standards for disaster and trauma competencies, is divided into three sections: Disaster Mental Health Counseling Foundations, Disaster and Trauma Response in the Community, and Disasters and Mass Violence at Schools and Universities. Real-world responses to violence and tragedies among diverse populations in a variety of settings are presented, and responders share their personal stories and vital lessons learned through an "In Our Own Words" feature. Each chapter contains discussion questions and case studies are interwoven throughout the text.

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• To purchase print copies, please visit the ACA website

• Reproduction requests for material from books published by ACA should be directed to [email protected]

Section 1
Disaster Mental Health Counseling: Foundations

Chapter 1
Understanding Disaster Mental Health

Jane M. Webber and J. Barry Mascari

Disasters have wreaked havoc in people's lives since earliest times. Hurricanes, fires, and earthquakes are among catastrophic natural disasters that occur throughout the world, and people living in vulnerable geographic areas face the potential of disasters, such as tornadoes and wildfires, as a daily threat. Human-caused disasters (e.g., wars, political conflict, mass violence, and catastrophic accidents) have also deeply affected individuals and communities. The September 11, 2001, terrorist attacks shattered Americans' sense of safety, dramatically changing their world view so that if you see something, say something is a continuous civic responsibility. The long-term psychological impact on survivors and families of victims continues even 15 years after the World Trade Center tragedy (Fetchett, 2016). Schools and universities, historically considered places of safety for children, are now targets for shooters, and lock-down drills are standard practice in elementary and secondary schools. Furthermore, the plight of Syria's people during the current civil war has been called the “largest humanitarian crisis since World War II” (Clay, 2017, p. 34). Civil war and persecution have affected more than 20 million refugees and 40 million people internally displaced in Syria, Afghanistan, Iraq, Somalia, and other countries. Social media, electronic communication, and continuous television coverage instantly bring these disasters into people's living rooms.

In times of crisis and disaster, Fred Rogers (2013) reminded us, “If you look for the helpers, you'll know that there's hope” (0:51). Counselors and disaster mental health (DMH) professionals are these helpers. The enormity and ubiquity of mass tragedies underscore the need for trained and ready DMH responders in the “era of mass violence” (Mascari, Webber, & Kitzinger, 2015). Although they might not be able to volunteer or deploy to distant sites, all counselors and mental health professionals should be prepared and ready to assist those affected by mass traumatic events, particularly in their own communities. In this chapter, we describe the organized response to disasters and examine the role of DMH counselors in response to various types of disaster and mass violence events. We follow the development of DMH counseling as a professional specialization as well as advancements in national training, preparedness, and response.

Protect, Direct, Connect

In August 2005, thousands of people huddled in the New Orleans Superdome or were stranded and desperate on the roofs of buildings surrounded by rising floodwaters from levees breached by Hurricane Katrina. Individuals were better able to cope and survive if they could (a) protect themselves from danger and trauma in a shelter or a safe place; (b) direct their attention to immediate priorities of food, water, and medical needs and restore a sense of hope and meaning; and (c) connect to family and friends for support. These three priorities reflect the purposes of DMH and psychological first aid goals and tasks (Crimando, 2009; Myers & Wee, 2005).

Terrorist attacks in France (Paris and Nice), at the Boston Marathon, and the Inland Regional Center in San Bernardino, California have heightened individual and community fear, increasing Islamophobia in the United States and abroad. An atmosphere of dread pervades American daily routines at athletic events, concerts, schools, and universities. With growing numbers of events-turned-violent at the Las Vegas music festival, Orlando nightclub, and the Ariana Grande concert in Manchester, England, “the expectation of psychological trauma and posttraumatic stress disorder is now part of our national consciousness” (Reyes & Elhaida, 2004, p. 399). Disaster, crisis, and trauma counseling skills and response are now an essential part of counselor training and practice (Council for Accreditation of Counseling and Related Educational Programs [CACREP], 2016).

Types of Disasters

How people view disasters and traumatic events influences their reactions. The United Nations defines a disaster as “a serious disruption of the functioning of society, causing widespread human, material, or environmental losses which exceed the ability of affected society to cope using only its own resources” (United Nations International Strategy for Disaster Reduction, 2009, p. 9). The International Federation of Red Cross and Red Crescent Societies (2016) echoed the United Nations' description, adding the qualifier “a sudden calamitous event” (para. 1). A disaster frequently follows a crisis or an emergency when “people are unable to meet their basic survival needs, or there are serious and immediate threats to human life and well-being . . . normal procedures are suspended and extraordinary measures are taken in order to avert a disaster” (World Health Organization, 2003, p. 3). Crises are often explained in terms of the Chinese character that is the combination of two characters: danger and opportunity. Thus, a crisis is a highly distressful event or time when people are overwhelmed and cannot function with normal coping skills. A crisis might lead to an emergency or a disaster that affects many people. Disasters can be categorized by factors such as demographics, geography, culture, cause, or impact—economic, political, ecological, health, social, technological, or human (Pearce, 2000).

Natural Disasters

Natural disasters are classified by weather (e.g., storm, snow), earth movement such as earthquakes; or biological or ecological impacts such as global warming, rainforest destruction, or pandemic (Tracy, 2012). These events share similar elements, but the impact of each is unique, and the response depends on past disaster experiences, population, preparation, federal and state support, and resources (Norris, 1992; Pynoos, Steinberg, Schreiber, & Brymer, 2006). Although the impact of disasters is high, their occurrence is low; some geographic areas—for example, a valley may be vulnerable to flash floods, or a plain may be subjected to frequent tornadoes—are at higher risk. For such areas, perceived threat, preparation, and early warning systems for evacuation or taking shelter are key tasks for risk reduction. Disasters are also described as slow-onset or rapid-onset, predictable (e.g., blizzard, hurricane) or without advance notice (e.g., earthquake), and with immediate impact (e.g., deaths by flooding and drowning) or long-term consequences (e.g., chemical or oil contamination, radiation). In Table 1.1, disasters are categorized as natural, human caused, or with human influence.

Table 1.1 Types of Disasters

Natural Disaster	Human Caused	With Human Influence
Flood, tsunami Earthquake, aftershock Hurricane, tornado, superstorm, cyclone, typhoon Thunder, rainstorm Snowstorm, ice storm, blizzard, avalanche, landslide Fire, wildfire, forest fire Extreme temperature Volcanic eruption Landslide, mud, rock Fallen tree, debris Lightning strike, meteorite Famine Dust storm Disease, pestilence, pandemic, epidemic, fatal illness Unexpected or unexplained death, injury Bridge, road damage	War, military conflict, political takeover, invasion Hostage taking Terrorist attack Riot, mob, stampede, accidental mass violence Aggression, physical attack, shooting, stabbing, torture, homicide, genocide Assassination Bombing, explosion Aircraft crash, as a weapon, hijacking Contamination; exposure; poisoning of water, food, medicine, air Nuclear, chemical, biological weapon attack Technology, cyberweapon attack Chemical, industrial accident, oil spill Large train, ship, road accident Mass suicide, suicide pact	Pollution, ecosystem impact, deforestation Dam, levee breech or damage, with flooding Bridge, road damage Global warming Radiation leak, nuclear accident, reactor meltdown Fire by arson, accidental Mine fire, collapse Lack of immunization Hazardous waste Gas leak, explosion Electrocution Transportation accident with aircraft, bridge, ship, tunnel, train, auto Building, structural collapse; power plant accident Exposure to toxin, toxic pollution Complex humanitarian emergency Displacement, relocation, resettlement, migration, asylum, refugee crisis Economic decline, collapse
Note. For additional information, see J. Halpern and Tramontin (2007), Mascari and Webber (2010a, 2010b), Substance Abuse and Mental Health Services Administration (2014), Tracy (2012), and Webber and Mascari (2016).

Mass Violence and Terrorism

Mass violence is an intentional attempt to kill multiple individuals that might stem from extremism or terrorism (Anti-Defamation League, 2016). Terrorists plan to disrupt normalcy by instilling psychological fear, vulnerability, terror, and powerlessness and by maximizing death as well as physical and economic destruction. More mass shootings have occurred in the United States within the past decade than ever. From 1966 to 2012, 90 mass killings were recorded in the United States, composing almost 31% of the world's shootings, and three fourths of the guns used were legitimately obtained (see Chapter 7 regarding the Pulse shooting in Orlando, and Chapters 14 and 15 regarding school shootings.). As members of emergency management response teams in their organizations and communities, counselors can take proactive steps to assess vulnerability, identify potential perpetrators with the help of the community, and raise awareness of the importance for individuals to be more mindful of their surroundings and to trust “the gift of fear” (De Becker, 1997).

Complex Humanitarian Emergency (CHE)

Disasters also include mass emergencies in which serious political, economic, and social changes deeply affect thousands of people, such as in Syria, Bosnia, Rwanda, or Kosovo. The World Health Organization (2016) defined a complex humanitarian emergency (CHE) as follows:

A humanitarian crisis in a country, region, or society where there is total or considerable breakdown of authority resulting from internal or external conflict and which requires an international response that goes beyond the mandate or capacity of any single and/or ongoing UN country program. (para. 29)

These social emergencies often reflect the impact of war with massive loss of life from murder, disease, and famine; displaced people in-country (often because of ethnic cleansing); and forced migrations to survive (Klugman, 1999). The exodus from Syria beginning in 2011 and escalating to crisis levels in 2015 and 2016 has forced people to undergo migrations from country to country with major loss of life and property, starvation, extreme suffering, and deprivation (European University Institute Migration Policy Centre, 2016).

A CHE can be categorized by war, refugees, disease, and hunger that require a political, social, and global response. CHEs are typically assessed by the number of (a) war casualties, (b) un...